Health Services Administration Commons^™

Medicare Competitive Pricing: Lessons Being Learned In Phoenix And Kansas City, Nora Super

National Health Policy Forum

Written as policymakers scrutinized two Medicare competitive bidding demonstration projects set to take place in Phoenix and Kansas City, this issue brief analyzes two demonstration projects designed to test whether Medicare could pay health plans in a competitive manner. The brief reviews decisions made by the Competitive Pricing Advisory Commission (CPAC), including design considerations such as plan eligibility and participation, the standard benefit package, the bidding process, and the government contribution to premiums. It also looks at the reasons for opposition to the project and the relationship of this demonstration to broader efforts to reform the Medicare program.

The Public Stake In Biomedical Research: A Policy Perspective, Karen Matherlee

National Health Policy Forum

An introduction to a Forum series on biomedical research policy issues, this paper provides background on the organization and structure of both public and private research entities. It outlines the federal components, from the National Institutes of Health (NIH) to the Department of Veterans Affairs. It also looks at the rapid growth in pharmaceutical, biotechnology, and medical device research and development and the varying responses from managed care plans, practice-based research networks, and contract research organizations. After laying out various tensions in the field, such as competition among disease-oriented advocates, alignment of different priorities, allocation of dollars between basic and …

The Abcs Of Pbms, Robin J. Strongin

National Health Policy Forum

This issue brief describes the evolution of the pharmacy benefit manager (PBM) industry since the late 1960s and outlines current business practices in the areas of payment, services, drug formularies, and rebates. Tools of the trade, such as cost-sharing and generic substitution, used to control costs and improve quality are also discussed.

Chip And Medicaid Outreach And Enrollment: A Hands-On Look At Marketing And Applications, Judith D. Moore

National Health Policy Forum

The State Children's Health Insurance Program (SCHIP or CHIP), enacted as part of the Balanced Budget Act (BBA) in 1997, has enrolled eligible low-income children in innovative ways and tackled a variety of challenges to make sure that families know about the new program. This issue brief describes the outreach, application, and enrollment process for both SCHIP and Medicaid, analyzing the difficulty in simplifying applications, and noting problems that states must solve around systems design, immigration issues, and the stigma sometimes associated with government programs.

Site Visit To Baltimore And Fort Detrick, Maryland — Preparing For A Bioterrorist Incident: Linking The Public Health And Medical Communities, Robin J. Strongin

National Health Policy Forum

As follow-up to the NHPF's February 1999 session entitled "Biological Terrorism: Is the Health Care Community Prepared?" the Forum organized a site visit on October 4 and 5, 1999, to Baltimore and Fort Detrick, Maryland. The site visit provided federal congressional and agency staff with the opportunity to learn first-hand how one local area is preparing for the possibility of a bioterrorist incident. Several themes were stressed throughout the two days, including the following: distinguishing bioterrorism from chemical terrorism, understanding the relationships between various agencies and institutions and their related funding streams, determining how the federal government can …

A Chicken (Nugget?) In Every Pot: What's At Stake In The Budget Debate, Karl Polzer

National Health Policy Forum

This paper explores various aspects of the 1999 budget debate fueled in large part by federal agencies' projection of a $2.9 trillion surplus over 10 years. The tax bill, which would provide about $400 billion in tax relief, is also discussed; special attention is given to the health care provisions of this legislation.

The Nursing Center In Concept And Practice: Delivery And Financing Issues In Serving Vulnerable People, Karen Matherlee

National Health Policy Forum

This issue brief looks at ways in which nurse-managed centers — with support from the Health Resources and Services Administration and private foundations — are carving a role in providing preventive and primary care to vulnerable populations. Two case studies — one in Philadelphia and the other in the Utah-Nevada border area — llustrate nursing centers' mission, outreach, services, workforce, payment concerns, and educational tie-ins.

Mental Health Coverage Parity: Separating Wheat From Chaff, Karl Polzer

National Health Policy Forum

This paper examines the issue of mandating parity in coverage of mental health services in the context of the growing use by private-sector employers of managed behavioral health care providers. Existing parity laws are reviewed, along with estimates of the costs of parity. The tools used by behavioral health care firms to manage care and costs are also discussed.

Quality Of Care In Investor-Owned Vs Not-For-Profit Hmos, David U. Himmelstein, Steffie Woolhandler, Ida Hellander, Sidney M. Wolfe

Publications and Research

Context The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs.

Objective To compare quality-of-care measures for investor-owned and not-for-profit HMOs.

Design, Setting, and Participants Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States.

Main Outcome Measures Rates for 14 HEDIS quality-of-care …

Access To Home Health Services Under Medicare's Interim Payment System, Nora Super

National Health Policy Forum

This issue brief explores the impact of the interim payment system (IPS) for home health agencies established under the Balanced Budget Act of 1997 (BBA). IPS was intended to constrain program outlays by imposing limits on spending per beneficiary and spending per visit in the existing cost-based reimbursement system. This issue brief examines the impact of the IPS on access to home health care, including home health agencies' responses to the payment system and its impact on provider availability and, ultimately, access to care for the sickest or most expensive populations

Implementing The Bba: The Challenge Of Moving Medicare Post-Acute Services To Pps, Karen Matherlee

National Health Policy Forum

This issue brief examines the challenge of putting skilled nursing facilities (SNFs), medical rehabilitation units, and home health under prospective payment, requiring the development of classification systems for each. It looks at the three-year phase-in of SNF resource utilization groups (RUGs) that began July 1, 1998 and the debate over classification systems for medical rehabilitation facilities and home health. The paper goes beyond issues of classification to consider coordination problems in placing these post-acute services under Medicare PPS.

Canada's Generalist Training: Are There Lessons For The United States?, Lee Hawkins

National Health Policy Forum

Addressing the premise of an inappropriate skewing of the U.S. medical education system toward specialty medicine, this issue brief compares and contrasts the U.S. and Canadian graduate medical education (GME) systems, including the organization and financing of each. The issue brief also explores various lessons that might be learned from the Canadian GME system, such as full integration of primary care and GME and the use of incentives to achieve desired policy goals.

An Analysis Of Implementation Issues Relating To Chip Cost-Sharing Provisions For Certain Targeted Low Income Children, Sara J. Rosenbaum, Anne Rossier Markus, Dylan Roby

Health Policy and Management Issue Briefs

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP …

Reducing Medical Error: Can You Be As Safe In A Hospital As You Are In A Jet?, Lisa Sprague

National Health Policy Forum

This issue brief looks at the incidence of error in the health care system, opportunities for a systems-based approach to error reduction, and changes needed in health system culture and training. The lessons of human factors research are considered, with examples of their application in the aviation industry. The paper reviews some error-reduction and patient-safety initiatives undertaken by private-sector organizations and by the Veterans Health Administration.

Substance Abuse Prevention: Could An Improved D.A.R.E. Program Help Bridge The Gap Between Research And Practice?, Colomba Sirica

National Health Policy Forum

This issue brief provides background information on the popular Drug Abuse Resistance Education (D.A.R.E.) program, begun in 1983 and supported by education and law enforcement communities throughout the country to provide drug abuse prevention programs in schools. It describes recent efforts to conduct evaluative studies to assess the short- and long-term impact of the D.A.R.E. curriculum on drug-using behavior of children and youth and the new dialogue opening between D.A.R.E. proponents and the research community.

Hipaa As A Regulatory Model: Early Experiences And Future Prospects, Karl Polzer

National Health Policy Forum

In the context of the debate over bolstering consumer protection in health care without imposing excessive costs or onerous regulatory requirements, this paper examines the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as a regulatory model. The paper reviews the provisions of the legislation, examines the roles of the Department of Labor and the Health Care Financing Administration in implementing HIPAA, raises issues surrounding implementation and enforcement, and examines the usefulness of the HIPAA model as a vehicle for applying consumer protection measures.

Margins As Measures: Gauging Hospitals' Financial Health, Karen Matherlee

National Health Policy Forum

Recognizing the considerable controversy over ways to measure hospitals' financial viability, this issue brief reviews various ways to assess their fiscal strength. The paper looks first at operating margins, traditional measures that some experts say are inadequate when considered alone. It then explores several recommendations: (a) net income, liquidity and cash flow, and debt burden, suggested by the National Advisory Panel; (b) factors that determine year-to-year changes in hospitals costs, such as hospital input price inflation, changes in care patterns, and the complexity of patients treated, put forth by the Medicare Payment Advisory Commission; and (c) 35 financial indicators and …

Examining The Links Between Retirement And Health Insurance: Implications For Medicare Eligibility, Nora Super

National Health Policy Forum

This issue brief examines trends in labor force participation and health care coverage for early retirees, as well as the relationship between retirement and health insurance and health status.

Providing Outpatient Prescription Drugs Through Medicare: Can We Afford To? Can We Afford Not To?, Robin J. Strongin

National Health Policy Forum

The continuing debate over the issue of Medicare coverage for outpatient prescription drugs gave rise to this background paper, which discussed several key questions: Whose responsibility is it to provide coverage? Who should be covered? What should be covered? Who should pay for prescription drug coverage? How should costs be controlled? In addition, the paper explored options for structuring a Medicare outpatient prescription drug benefit. It also contained a glossary.

Welfare Reform And Its Impact On Medicaid: An Update, Judith D. Moore

National Health Policy Forum

Welfare reform, enacted in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), had a profound impact on the Medicaid program, delinking Medicaid from the new TANF program and for the first time allowing Medicaid eligibility to be divorced from welfare status. This paper reviews the national impact of this decoupling, describing research, implementation activities, and the impact of new state welfare programs on health programs in general.

Biological Terrorism: Is The Health Care Community Prepared?, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of biological warfare and discusses the role of the Centers for Disease Control (CDC) and state health departments in detecting biologic agents. The brief also highlights the issue of threat assessment and discusses ways to improve the current level of preparedness as well as steps needed to convert the public health system into our best form of civil defense.

Medicare Hmo Pullouts: What Do They Portend For The Future Of Medicare+Choice?, Nora Super

National Health Policy Forum

National policymakers became alarmed in the fall of 1998 when, contrary to expectations, nearly 100 Medicare HMOs announced their decisions to pull out of Medicare in certain areas or to reduce their service areas. This issue brief explores the reasons plans withdrew from certain areas, the Balanced Budget Act of 1997 provisions that most directly influenced these decisions, the impact of the withdrawals on Medicare beneficiaries, and policy options for ensuring the viability of the Medicare+Choice program.

Filling The Geriatric Gap: Is The Health System Prepared For An Aging Population?, Janet Firshein

National Health Policy Forum

This issue brief explores the field of geriatrics, the ways practitioners meet the health care needs of the elderly, training gaps, and the impact of Medicare payment policies on the delivery of health care to older Americans.

The Continuing Decline In Medicaid Coverage, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

A Comparison Study Of Food Facility Inspection Scores And Consumer Complaints, Debora Kim Leuer

Theses Digitization Project

No abstract provided.

Cognitively Impaired Elderly Individuals And Durable Powers Of Attorney For Healthcare, Nicole Rae Newman

Theses Digitization Project

No abstract provided.

Benchmarking Financial Operations Using The Premier Operations Outlook Database, Margaret M. Thompson

Community & Environmental Health Theses & Dissertations

Acute-care hospitals have come under increased pressure to reduce costs while increasing the quality of providing care. Historically, increasing costs of providing care has had the greatest impact on the reduction of operating margins necessary to expand capital and for repayment of debt. Facilities can benchmark internal historical data to identify areas where costs have increased and are able to explain the factors that contribute to the increases. One of the challenges facing hospitals in their efforts to reduce operating costs is how, what, and where, do they obtain comparative data to benchmark the cost of operating medical facility to …

Classification Of Participants Into Two Health Resource Utilization Groups By The Health Enrollment Assessment Review (Hear) Survey, Jody W. Donehoo

Health Services Research Dissertations

The study examined the ability of the Health Enrollment Assessment Review (HEAR) survey instrument to classify participants into one of two groups according to utilization of health resources anticipated in the following year. Developed by the U.S. Air Force, the HEAR survey is used worldwide by the Department of Defense for enrollees in TRICARE Prime, the military's adaptation of the HMO model of managed care. Individual HEAR reports are prepared for survey participants and their primary care providers in TRICARE Prime. Although it is currently administered worldwide to a majority of the 8.4 million health care beneficiaries of the Department …

Centred Voices : A Study Of The Lived Experience Of Women's Health Centre Coordinators, Jodie L. Moyle

Theses: Doctorates and Masters

The purpose of this phenomenological study is to explore and describe the lived experience of women's health centre coordinators. In addition to the intrinsic value of telling these women's stories, this research provides data which can he used to strengthen the economic, political, organisational and social position of women’s health centres and the women who work in them. Four women managers from regional urban women's health centres in Australia were interviewed about their subjective experiences with respect to their current working roles. Interviews were audio taped, transcribed and coded to produce themes and to preserve anonymity. Data was analysed using …